Annual Report to the Nation on the Status of Cancer, 1975-2012, featuring the increasing incidence of liver cancer

Abstract

Background: Annual updates on cancer occurrence and trends in the United States are provided through an ongoing collaboration among the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This annual report highlights the increasing burden of liver and intrahepatic bile duct (liver) cancers.

Methods: Cancer incidence data were obtained from the CDC, NCI, and NAACCR; data about cancer deaths were obtained from the CDC's National Center for Health Statistics (NCHS). Annual percent changes in incidence and death rates (age-adjusted to the 2000 US Standard Population) for all cancers combined and for the leading cancers among men and women were estimated by joinpoint analysis of long-term trends (incidence for 1992-2012 and mortality for 1975-2012) and short-term trends (2008-2012). In-depth analysis of liver cancer incidence included an age-period-cohort analysis and an incidence-based estimation of person-years of life lost because of the disease. By using NCHS multiple causes of death data, hepatitis C virus (HCV) and liver cancer-associated death rates were examined from 1999 through 2013.

Results: Among men and women of all major racial and ethnic groups, death rates continued to decline for all cancers combined and for most cancer sites; the overall cancer death rate (for both sexes combined) decreased by 1.5% per year from 2003 to 2012. Overall, incidence rates decreased among men and remained stable among women from 2003 to 2012. Among both men and women, deaths from liver cancer increased at the highest rate of all cancer sites, and liver cancer incidence rates increased sharply, second only to thyroid cancer. Men had more than twice the incidence rate of liver cancer than women, and rates increased with age for both sexes. Among non-Hispanic (NH) white, NH black, and Hispanic men and women, liver cancer incidence rates were higher for persons born after the 1938 to 1947 birth cohort. In contrast, there was a minimal birth cohort effect for NH Asian and Pacific Islanders (APIs). NH black men and Hispanic men had the lowest median age at death (60 and 62 years, respectively) and the highest average person-years of life lost per death (21 and 20 years, respectively) from liver cancer. HCV and liver cancer-associated death rates were highest among decedents who were born during 1945 through 1965.

Conclusions: Overall, cancer incidence and mortality declined among men; and, although cancer incidence was stable among women, mortality declined. The burden of liver cancer is growing and is not equally distributed throughout the population. Efforts to vaccinate populations that are vulnerable to hepatitis B virus (HBV) infection and to identify and treat those living with HCV or HBV infection, metabolic conditions, alcoholic liver disease, or other causes of cirrhosis can be effective in reducing the incidence and mortality of liver cancer. Cancer 2016;122:1312-1337. © 2016 American Cancer Society.

Keywords: Epidemiology; National Program of Cancer Registries (NPCR); North American Association of Central Cancer Registries (NAACCR); Surveillance; and End Results (SEER); cancer; incidence; liver cancer; mortality; survival; trends; viral hepatitis.

Figure 1

Age-adjusted incidence rates for 2008 to 2012 of liver and intrahepatic bile duct cancer are illustrated by state for areas in the United States with high-quality incidence data. Rates are per 100,000 persons and were age-adjusted to the 2000 US standard population (19 age groups: ages <1 year, 1–4 years, 5–9 years, …, 80–84 years, ≥85 years [Census publication p25-1130; US Bureau of the Census, Current Population Reports, p25-1130. Washington, DC: US Government Printing Office; 2000]). Source: National Program of Cancer Registries and Surveillance, Epidemiology, and End Results areas reported by the North American Association of Central Cancer Registries as meeting high-quality incidence data standards for the specified time. Rates from 2008 to 2012 for non-Hispanic (NH) whites, NH blacks, NH American Indians/Alaska Natives (Contract Health Services Delivery Area 2012 counties), NH Asians/Pacific Islanders, and Hispanics (48 states: Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming).

Figure 2

Age-specific incidence rates from 2008 to 2012 of liver and intrahepatic bile duct cancer are illustrated by race or ethnicity for areas in the United States with high-quality incidence data. Rates are per 100,000 persons and were age-adjusted to the 2000 US standard population (19 age groups: ages <1 year, 14 years, 5–9 years, …, 80–84 years, ≥85 years [Census publication p25-1130; US Bureau of the Census, Current Population Reports, p25-1130. Washington, DC: US Government Printing Office; 2000]). Source: National Program of Cancer Registries and Surveillance, Epidemiology, and End Results areas reported by the North American Association of Central Cancer Registries as meeting high-quality incidence data standards for the specified time. Rates from 2008 to 2012 for non-Hispanic (NH) whites, NH blacks, NH American Indians/Alaska Natives (AI/AN) (Contract Services Delivery Area [CHSDA] 2012 counties), NH Asians/Pacific Islanders (API), and Hispanics (48 states: Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming).

Figure 3

Cohort rate ratios (horizontal blue lines) and 95% confidence intervals (blue shading) are illustrated for the incidence of liver and intrahepatic bile duct cancer by race or ethnicity relative to the experience of the 1943 reference birth cohort (Surveillance, Epidemiology, and End Results [SEER]-13 areas, 1992–2012). The vertical lines indicate a rate ratio of 1 (no difference between a select birth cohort and the reference cohort). API indicates Asian/Pacific Islander. Source: SEER-13 areas covering about 14% of the US population (Connecticut, Hawaii, Iowa, Utah, and New Mexico; the Alaska Native Tumor Registry; rural Georgia; and the metropolitan areas of San Francisco, Los Angeles, San Jose-Monterey, Detroit, Atlanta, and Seattle-Puget Sound).

Figure 4

Age-specific liver and intrahepatic bile duct cancer incidence rates are illustrated by race or ethnicity and by age and year of diagnosis in the Surveillance, Epidemiology, and End Results (SEER)-13 areas from 1992 to 2012. Rates are per 100,000 persons. API indicates Asian/Pacific Islander. Source: SEER-13 areas covering about 14% of the US population (Connecticut, Hawaii, Iowa, Utah, and New Mexico; the Alaska Native Tumor Registry; rural Georgia; and the metropolitan areas of San Francisco, Los Angeles, San Jose-Monterey, Detroit, Atlanta, and Seattle-Puget Sound).

Figure 5

Crude death rates associated with hepatitis C virus and liver or intrahepatic bile duct cancer are illustrated among decedents aged ≥35 years according to (A) birth cohort and year and (B) birth cohort and age for the United States from 1999 to 2013. Rates are per 100,000 persons. Hepatitis C virus was defined according to the International Classification of Diseases 10th Revision (ICD-10) codes B17.1 and B18.2. Liver and intrahepatic bile duct cancers were defined by any ICD-10 code in the C22 ICD-10 category. Patients who died from liver or intrahepatic bile duct cancers had hepatitis C and liver or intrahepatic bile duct cancer listed together as any cause of death on their death certificate. Source: National Center for Health Statistics public-use data file for the total United States, 1999 to 2013.